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PubMedDate not supplied

[Current problems in thoracic injuries].

The authors stress the increased frequency in the recent years of single thoracic trauma and of thoracic trauma in the frame of polytraumatic lesions. The fact is stressed that the severity of thoracic trauma is usually determined by pathophysiological syndromes generated sometimes by minor anatomical lesions. An original classification is presented, of thoracic trauma, the present etiopathogenetic concept is discussed, as well as pathophysiologic syndromes consecutive to thoracic trauma. The major types of lesions are illustrated by clinical cases. The treatment of thoracic trauma should respect in the first place the principle of re-equilibration of vital functions that have been disturbed. Only after this has been achieved integrity of the anatomic structures of the organs involved should be attempted. Surgical indications are justified only if the anatomical lesions are the origin of a cardio-respiratory imbalance that cannot be eliminated but by surgical procedures. An original procedure is presented, that of Prof. C. Coman, which achieves immobilization of the flaps with the aid of blades, and the advantages of this system are stressed.

Adolescent↗
PubMedDate not supplied

Solitary hot spots in the ribs on bone scan: value of thin-section reformatted computed tomography to exclude radiography-negative fractures.

PURPOSE: The purpose of this study was to classify solitary, scintigraphy-positive and radiography-negative rib lesions and to clarify the features of rib fractures by using thin-section reformatted helical computed tomography (CT). METHODS: Forty-seven patients whose whole-body bone scans showed a solitary hot spot in a rib as their first abnormal scintigraphic finding and whose plain radiograph showed negative or indeterminate results were examined by thin-section reformatted CT. Final diagnosis was based on follow-up over a 20-month period. RESULTS: The final diagnosis included 17 cases of fractures where CT findings were fracture line, focal sclerosis, and callus formation. Fourteen ribs demonstrated intramedullary, focal osteosclerosis, and 8 ribs did not demonstrate any abnormalities. Four metastatic lesions appeared as intramedullary mixture of osteolysis and osteosclerosis, or bone destruction. Four intramedullary lesions with cystic appearance remained unchanged. CONCLUSIONS: Thin-section reformatted helical CT delineated minute, radiographically occult fractures of the rib. Excluding fractures, helical CT can avoid further unnecessary examinations.

Adult↗
PubMed1980

Unsuspected costo-vertebral fractures demonstrated by bone scanning in the child abuse syndrome.

Many patterns of injury have been described in the child abuse syndrome. Until recently, all the bone manifestations of this syndrome have been diagnosed radiologically. Four cases of multiple costovertebral fracture diagnosed by bone scan are described and their etiology discussed. The use of bone scanning in identifying fractures which previously would have been missed is advocated.

Child Abuse↗
PubMed1984

[Gunshot injuries in peacetime and their therapy].

Between 1976 and 1982 46 patients with gunshot injuries (43 m., 3 f.) were seen at the University of Heidelberg Department of Surgery. Frequent causes of injury in 42 adults (40 m., 2 f.) and 4 children (3 m., 1 f.) were suicide attempts (19) and carelessness in the handling of shotguns (11). Criminal offence was related to nine injuries; no retrospective classification of the event causing the injury was possible in further seven cases. Affected in descending order of frequency were brain and lung (10 each), soft tissue of thigh (9), intraabdominal organs (5), heart (4), liver and bone (3 each), blood vessels (2) and facial skull, penis, buttock, neck and mediastinum (1 each). Six patients suffered from combined injuries, in three cases a combined abdomino-thoracic injury was seen. Whilst suicidal injuries of the skull are related to poor prognosis, other peacetime gunshot wounds are less problematic when compared to military gunshot wounds due to the lower speed of the projectiles. Therapeutic procedures follow the general rules of open treatment of injuries including prophylaxis against tetanus and botulism as well as systemic antibiotic therapy. In general abdominal and abdomino-thoracic gunshot wounds as well as vascular injuries require immediate surgical procedure. In isolated thoracic injuries a conservative approach may be justified depending on the situation. The same rule applies to fractures caused by gunshots.

Abdominal Injuries↗
PubMed1986

Cardiac contusion in patients wearing seat belts.

The incidence of myocardial contusion in patients wearing seat belts and requiring admission to hospital after road traffic accidents was examined. The criteria used for diagnosing contusion were serial electrocardiograms (ECGs) and estimation of CK-MB isoenzymes using the Isomune-CK (Roche) kit. Nine of the 14 patients (64 per cent) showed evidence of myocardial contusion. We suggest long-term studies to establish the true incidence among patients wearing seat belts.

Accidents, Traffic↗
PubMed2004

Intrathoracic humeral head fracture-dislocation.

There are few cases in the medical literature documenting intrathoracic glenohumeral fracture-dislocations. A total of eight cases have been reported-two intrathoracic humerus dislocations with greater tuberosity fractures 1, 2 and six cases with intrathoracic fracture-dislocations in which the fracture involved the humeral neck. 3-8 With so few cases, treatment modalities vary, and no guidelines exist. Patients in five of the reported cases underwent surgery, 1, 3-6 while the other three were treated nonoperatively. 2, 7, 8 We present a case of a middle-aged woman involved in a high-speed motor vehicle accident who sustained an intrathoracic humeral head fracture-dislocation and underwent operative treatment.

Arthroplasty↗
PubMed1976

[Thoracic injuries and resuscitation. Case reports and critical review].

A series of 68 chest injuries treated at the Resuscitation and Intensive Care Unit. S. Orsola Policlinic, Bologna, between May 1967 and December 1973 is presented. Treatment was given by the staff of the anaesthesia and resuscitation service and the chest surgery section, 2nd Surgical Clinic, University of Bologna. The types of case observed and the treatment methods employed are bierfly explained, together with the clinical and statistical data. Emphasis is laid on the relation between clinical course and blood gas values. The value of tracheostomy and protracted intubation is discussed, together with the utility of antalgic and psychosedative management. The increased frequency of bronchopneumonic complications is noted. Encouraging results obtained by surgical stabilisation of movable flaps by means of Kirschner wires are reported. While this method admittedly requires thoracotomy, this in itself has the advantage of enabling existing pleural and pulmonary lesions to be repaired.

Adolescent↗
PubMed1988

Fractures on chest radiographs in detection of alcoholism.

The prevalence of fractures seen on chest radiographs among alcoholics varies in various series from 36.0% to 8.7% while that for controls remains below 5%. The aim of our study was to find out whether the selection of the alcoholic subjects could account for this four-fold variation. We therefore chose two groups of alcoholics, group 1 consisting of 76 mainly unmarried or divorced lower class alcoholics who had attended the emergency department while intoxicated, and group 2 consisting of 108 mainly married middle class alcoholics with alcoholic liver cirrhosis. The control group consisted of 98 randomly chosen hospital patients. There was no significant difference between group 1 and group 2 in the prevalence of fractures detectable with chest radiography (25% and 21.3% respectively). 8.2% of the controls also had fractures. The fracture prevalence did not correlate with socioeconomic group. Married alcoholics had significantly less thoracic fractures than unmarried, divorced or widowed alcoholics as a group. The sensitivity and specificity of the fractures visible on chest radiograph as a marker for alcoholism is not sufficient to warrant its use in clinical or research work.

Adult↗